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CARDIOMYOPATHIES
Cardiomyopathies result in impairment of the whole person by causing abnormal ventricular function. Abnormal ventricular function may not result in abnormal hemodynamics, or it may result in pulmonary and/or systemic organ congestion and decreased cardiac output. Abnormal ventricular functions related to coronary heart disease, valvular heart disease, and hypertensive heart disease are covered in their respective sections. Cardiomyopathies may also cause arrhythmias; these are considered in a different section of this chapter. Some cardiomyopathies are reversible. Every effort should be made to identify the reversible forms and to treat them appropriately over an adequate period of time before estimating any suspected permanent impairment.
Impairment Classification for Cardiomyopathies
Class 1 Impairment of the Whole Person, 0—14% The patient is asymptomatic and there is evidence of impaired left ventricular function from clinical examination or laboratory studies; and There is no evidence of congestive heart failure orcardiomegaly from physical examination or laboratory studies.
Class 2 Impairment of the Whole Person, 15—29%The patient is asymptomatic and there is evidence of impaired left ventricularfunction from physical examination or laboratory studies; and Moderate dietary adjustment or drug therapy is necessary for the patient to be free of symptoms and signs of congestive heart failure; or The patient has recovered from surgery for the treatment of hypertrophic cardiomyopathy and meets the criteria above.
Class 3 Impairment of the Whole Person, 30-54%The patient develops symptoms of congestive heart failure on greater than ordinary daily activities (functional class 3) and there is evidence of abnormal ventricular function from physical examination or laboratory studies; and Moderate dietary restriction or the use of drugs is necessary to minimize the patient’s symptoms, or to prevent the appearance of signs of congestive heart failure or evidence of it by laboratory study; or The patient has recovered from surgery for the treatment of hypertrophic cardiomyopathy and meets the criteria described above.
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